Satisfaction with emergency obstetric and new born care services among clients using public health facilities in Jimma Zone, Oromia Regional State, Ethiopia; a cross sectional study

BMC Pregnancy and Childbirth, Volume 16, No. 1, Year 2016

Interpretation

Background: The 2005 report of United Nations Millennium Project of Transforming Health Systems for women and children concluded that universal access to Emergency Obstetric and New born Care could reduce maternal deaths by 74 %. Even though some studies investigated quality of Emergency Obstetric and New born Care in different parts of the world, there is scarcity of data regarding this issue in Ethiopia, particularly in Jimma zone. Therefore, the aim of this study was to assess satisfaction with Emergency Obstetric and new born Care services among clients using public health facilities in Jimma zone, Southwest Ethiopia. Methods: A facility-based cross sectional study was conducted in Jimma Zone from April 01-30, 2014. The data were collected by interviewing 403 clients, who gave birth in the past 12 months prior to data collection in 34 randomly selected public health facilities. The collected data were entered by using Epi-info version 3.5.4 and analysed using SPSS version 20.0. Linear regression analysis was done to ascertain the association between covariates and the outcome variable, and finally the results were presented using frequency distribution tables, graphs and texts. Results: The overall mean client satisfaction with Emergency Obstetric and New born Care services in this study was 79.4 %; 95 % CI (75 %, 83 %). The result of linear regression analysis revealed that a unit decrease in satisfaction to availability of drugs and equipment, decreased overall clients’ satisfaction by 0.23 unit 95 % CI (0.15, 0.31). Conclusions: The level of clients’ satisfaction with Emergency Obstetric and New born Care services was low in the study area. Factors such as availability of essential equipment and drugs, health workers’ communication, health care provided, and attitude of health workers had positive association with client satisfaction with Emergency Obstetric and New born Care services. This in turn could affect utilization of Emergency Obstetric and New born Care services and play a role in contribution to maternal and new born mortality. Therefore, the efforts of health facilities leaders and health care providers towards improvement of quality of care could contribute more for better maternal satisfaction. Facility-based cross-sectional study was conducted from April 1–30, 2014 to determine clients’ satisfaction with emergency obstetric and new born care services among clients using public health facilities in Jimma Zone, Ethiopia. Jimma zone has 17 districts and two town administrations, each being administratively responsible to the Zone. The total population of Jimma zone projected for the year 2014 from 2007 census was 3,030,740; of which, 94 % are rural residents and the rest are urban. The expected women of reproductive age group were 669,794 and the expected number of pregnant women in the zone was 116,077 in the year 2014. There are 4 public hospitals and 100 public health centres providing delivery service in the zone. The sample size of clients (mothers) was determined by using a single population proportion formula with P = 0.61 (proportion of mother’s satisfaction for delivery services in Amhara region referral hospitals) [7], level of significance 5 % (α = 0.05), margin of error 5 % (d = 0.05), and 10 % non-response rate. Accordingly, a total of 403 mothers who gave births in the past 12 months prior to the study period were the sample participants of the study. A handbook for monitoring emergency obstetric care [1] recommends, if there are 25 or fewer hospitals, to study all of them, and if there are more than 25 hospitals, to select a sub-set as many as possible that should represent at least 30 %; and for lower-level facilities including health centres, if there are 100 or fewer, to study all of them, and if there are more than 100, to select a sub-set as many as possible that should represent at least 30 %. Visiting all the health facilities in Jimma zone was difficult in terms of cost and availability of human power and time. Therefore, in order to minimize bias the existing health facilities were broadly listed according to facility type, namely, hospitals and health centres. Then, by using simple random sampling method 30 (30 %) health centres and all the four hospitals (100 %), thus a total of 34 health facilities, were selected for the study. Finally, the women who gave births in those facilities in the past 12 months prior to the study period were interviewed conveniently in proportionate to average monthly delivery load. A structured interview administered questionnaire was developed in English language and translated to Afan Oromo (local language) and back to English by independent language experts to keep the consistency. Training was given for data collectors about techniques of data collection and briefed on each question contained in the data collection tool. As well, the data collection instrument has been validated through conducting pre-test in health facilities nearby Jimma zone prior to the real data collection time. Finally, the required data were collected by interviewing women who were getting delivery services from health facilities using Afan Oromo version questionnaire. The questionnaire was composed of two parts: (i) Socio-demographic variables and (ii) 19 satisfaction related variables which came up with a high internal consistency (Cronbach’s alpha = 0.756). A five point Likert scale, coded as 1 = completely dissatisfied, 2 = somewhat dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = somewhat satisfied and 5 = completely satisfied was used to rate satisfaction with various aspects of health care. Satisfaction variables were grouped into six dimensions related to: (i) health facilities’ physical environment (8 questions), (ii) health workers’ communication (3 questions), (iii) health care provision (3 questions), (iv) health workers’ attitude (3 questions), and (v) overall satisfaction of clients (2 questions). The overall of clients’ satisfaction was measured with the summation of satisfaction levels of the independent variables. After obtaining the mean score of all independent satisfaction variables, the median of the result was calculated. Those who scored above the median were categorized as fully satisfied and those below the median were categorized as fully dissatisfied with the overall services. Emergency Obstetric and Newborn Care is a set of critical life saving functions commonly called signal functions provided by a health facility, 24 h a day, 7 days a week. Data were entered by using data entry software Epi Info version 3.5.4 and analysed using SPSS version 20.0. Frequencies and percentages were computed to describe major findings of the study. Linear regression analysis was done to identify variables which had association with clients’ satisfaction with EmONC services independently. Then, variables which had P-values < 0.2 in linear regression analysis were entered in to multivariable linear regression model for controlling possible effects of confounders. Thus, the association between covariate and the outcome variable was ascertained based on standardized Beta with 95 % Confidence Interval (CI) and P-values. A P-value of ≤0.05 was considered to identify factors associated with clients’ satisfaction with EmONC services, and finally data were presented using tables and texts.

AI Digest

Study Justification:

– The United Nations Millennium Project of Transforming Health Systems for women and children concluded that universal access to Emergency Obstetric and Newborn Care could reduce maternal deaths by 74%.
– There is a scarcity of data regarding the quality of Emergency Obstetric and Newborn Care in Ethiopia, particularly in the Jimma zone.
– Assessing satisfaction with Emergency Obstetric and Newborn Care services is important for improving the quality of care and reducing maternal and newborn mortality.

Highlights:

– The overall mean client satisfaction with Emergency Obstetric and Newborn Care services in the study was 79.4%.
– Factors such as availability of essential equipment and drugs, health workers’ communication, health care provided, and attitude of health workers had a positive association with client satisfaction.
– The level of clients’ satisfaction with Emergency Obstetric and Newborn Care services was low in the study area.

Recommendations:

– Health facilities leaders and health care providers should focus on improving the quality of care to increase client satisfaction.
– Efforts should be made to ensure the availability of essential equipment and drugs.
– Health workers should improve their communication skills and attitude towards clients.

Key Role Players:

– Health facilities leaders
– Health care providers
– Ministry of Health officials
– Community health workers
– Health facility administrators

Cost Items for Planning Recommendations:

– Procurement of essential equipment and drugs
– Training programs for health care providers
– Communication and awareness campaigns
– Quality improvement initiatives
– Monitoring and evaluation activities

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is a facility-based cross-sectional study, which provides valuable information but has limitations in establishing causality. The sample size of 403 clients is reasonable, but it would be helpful to know how representative these clients are of the overall population. The data collection methods and analysis techniques are clearly described. To improve the evidence, future studies could consider using a longitudinal design to establish causality and ensure a more representative sample of the population. Additionally, including a comparison group of clients using private health facilities would provide a more comprehensive understanding of client satisfaction.

Abstract

Facility-based cross-sectional study was conducted from April 1–30, 2014 to determine clients’ satisfaction with emergency obstetric and new born care services among clients using public health facilities in Jimma Zone, Ethiopia. Jimma zone has 17 districts and two town administrations, each being administratively responsible to the Zone. The total population of Jimma zone projected for the year 2014 from 2007 census was 3,030,740; of which, 94 % are rural residents and the rest are urban. The expected women of reproductive age group were 669,794 and the expected number of pregnant women in the zone was 116,077 in the year 2014. There are 4 public hospitals and 100 public health centres providing delivery service in the zone. The sample size of clients (mothers) was determined by using a single population proportion formula with P = 0.61 (proportion of mother’s satisfaction for delivery services in Amhara region referral hospitals) [7], level of significance 5 % (α = 0.05), margin of error 5 % (d = 0.05), and 10 % non-response rate. Accordingly, a total of 403 mothers who gave births in the past 12 months prior to the study period were the sample participants of the study. A handbook for monitoring emergency obstetric care [1] recommends, if there are 25 or fewer hospitals, to study all of them, and if there are more than 25 hospitals, to select a sub-set as many as possible that should represent at least 30 %; and for lower-level facilities including health centres, if there are 100 or fewer, to study all of them, and if there are more than 100, to select a sub-set as many as possible that should represent at least 30 %. Visiting all the health facilities in Jimma zone was difficult in terms of cost and availability of human power and time. Therefore, in order to minimize bias the existing health facilities were broadly listed according to facility type, namely, hospitals and health centres. Then, by using simple random sampling method 30 (30 %) health centres and all the four hospitals (100 %), thus a total of 34 health facilities, were selected for the study. Finally, the women who gave births in those facilities in the past 12 months prior to the study period were interviewed conveniently in proportionate to average monthly delivery load. A structured interview administered questionnaire was developed in English language and translated to Afan Oromo (local language) and back to English by independent language experts to keep the consistency. Training was given for data collectors about techniques of data collection and briefed on each question contained in the data collection tool. As well, the data collection instrument has been validated through conducting pre-test in health facilities nearby Jimma zone prior to the real data collection time. Finally, the required data were collected by interviewing women who were getting delivery services from health facilities using Afan Oromo version questionnaire. The questionnaire was composed of two parts: (i) Socio-demographic variables and (ii) 19 satisfaction related variables which came up with a high internal consistency (Cronbach’s alpha = 0.756). A five point Likert scale, coded as 1 = completely dissatisfied, 2 = somewhat dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = somewhat satisfied and 5 = completely satisfied was used to rate satisfaction with various aspects of health care. Satisfaction variables were grouped into six dimensions related to: (i) health facilities’ physical environment (8 questions), (ii) health workers’ communication (3 questions), (iii) health care provision (3 questions), (iv) health workers’ attitude (3 questions), and (v) overall satisfaction of clients (2 questions). The overall of clients’ satisfaction was measured with the summation of satisfaction levels of the independent variables. After obtaining the mean score of all independent satisfaction variables, the median of the result was calculated. Those who scored above the median were categorized as fully satisfied and those below the median were categorized as fully dissatisfied with the overall services. Emergency Obstetric and Newborn Care is a set of critical life saving functions commonly called signal functions provided by a health facility, 24 h a day, 7 days a week. Data were entered by using data entry software Epi Info version 3.5.4 and analysed using SPSS version 20.0. Frequencies and percentages were computed to describe major findings of the study. Linear regression analysis was done to identify variables which had association with clients’ satisfaction with EmONC services independently. Then, variables which had P-values < 0.2 in linear regression analysis were entered in to multivariable linear regression model for controlling possible effects of confounders. Thus, the association between covariate and the outcome variable was ascertained based on standardized Beta with 95 % Confidence Interval (CI) and P-values. A P-value of ≤0.05 was considered to identify factors associated with clients’ satisfaction with EmONC services, and finally data were presented using tables and texts.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote areas in Jimma Zone, Ethiopia, can improve access to maternal health services for women who live far from public health facilities.

2. Telemedicine: Introducing telemedicine services can allow pregnant women in Jimma Zone to consult with healthcare providers remotely, reducing the need for them to travel long distances for routine check-ups or consultations.

3. Community health workers: Training and deploying community health workers in Jimma Zone can help bridge the gap between healthcare facilities and the community. These workers can provide education, support, and basic healthcare services to pregnant women, improving access to maternal health services.

4. Improving availability of drugs and equipment: Ensuring that public health facilities in Jimma Zone have a consistent supply of essential drugs and equipment for emergency obstetric and newborn care can enhance the quality of care and increase client satisfaction.

5. Enhancing communication between health workers and clients: Implementing training programs to improve communication skills among healthcare providers can lead to better patient-provider interactions, increased satisfaction, and improved access to maternal health services.

6. Addressing healthcare provider attitudes: Conducting awareness campaigns and training programs to address any negative attitudes or biases among healthcare providers towards pregnant women can create a more supportive and respectful environment, encouraging women to seek maternal health services.

These innovations have the potential to improve access to maternal health services in Jimma Zone, Ethiopia, and contribute to better maternal and newborn outcomes.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health would be to focus on improving the satisfaction of clients with emergency obstetric and newborn care services in public health facilities in Jimma Zone, Ethiopia. This can be achieved by addressing the following factors:

1. Availability of drugs and equipment: Ensuring that essential drugs and equipment are readily available in public health facilities is crucial for providing quality emergency obstetric and newborn care. Efforts should be made to regularly stock and maintain these supplies to meet the needs of clients.

2. Health workers’ communication: Effective communication between health workers and clients is essential for providing satisfactory care. Health workers should be trained in communication skills to ensure clear and empathetic communication with clients, addressing their concerns and providing necessary information.

3. Health care provision: The quality of care provided by health workers plays a significant role in client satisfaction. Health facilities should strive to provide evidence-based and compassionate care, following best practices and guidelines for emergency obstetric and newborn care.

4. Attitude of health workers: The attitude of health workers towards clients can greatly impact their satisfaction. Health workers should be trained to provide respectful and non-judgmental care, creating a supportive and welcoming environment for clients.

By addressing these factors, public health facilities in Jimma Zone can improve the satisfaction of clients with emergency obstetric and newborn care services. This, in turn, can contribute to increased utilization of these services and ultimately reduce maternal and newborn mortality rates.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase availability of essential drugs and equipment: Ensuring that public health facilities have an adequate supply of essential drugs and equipment is crucial for providing quality emergency obstetric and newborn care. This can be achieved through regular monitoring and stock management systems.

2. Improve communication between health workers and clients: Effective communication between health workers and clients can enhance the overall satisfaction with maternal health services. Training programs can be implemented to improve communication skills of health workers, including active listening and clear explanation of procedures and treatment options.

3. Enhance the quality of health care provision: Improving the quality of care provided during childbirth and postpartum period can significantly impact maternal satisfaction. This can be achieved by implementing evidence-based practices, such as respectful maternity care, infection prevention, and pain management.

4. Foster positive attitudes among health workers: The attitude of health workers towards pregnant women and new mothers can greatly influence their satisfaction with maternal health services. Promoting a culture of empathy, respect, and non-discrimination among health workers can contribute to better overall experiences for clients.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage of facilities with adequate drug and equipment supply, client satisfaction scores, and utilization rates of maternal health services.

2. Collect baseline data: Gather data on the current status of maternal health services, including availability of drugs and equipment, client satisfaction levels, and utilization rates. This can be done through surveys, interviews, and data analysis of existing records.

3. Implement interventions: Introduce the recommended interventions in selected public health facilities. This could involve training programs for health workers, procurement of essential drugs and equipment, and quality improvement initiatives.

4. Monitor and evaluate: Continuously monitor the implementation of interventions and collect data on the selected indicators. This can be done through regular assessments, surveys, and data analysis. Compare the post-intervention data with the baseline data to assess the impact of the recommendations.

5. Analyze and interpret results: Analyze the collected data to determine the extent to which the recommendations have improved access to maternal health. This could involve statistical analysis, such as regression models, to identify associations between the interventions and the selected indicators.

6. Communicate findings and make adjustments: Present the results of the impact assessment to relevant stakeholders, including policymakers, health facility leaders, and health workers. Based on the findings, make necessary adjustments to the interventions to further improve access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further improvements.

Authors & Co-Authors

Statistics:

Citations: 12

Authors: 4

Identifiers:

DOI: 10.1186/s12884-016-0877-0

Research Areas:

Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female